Provider Demographics
NPI:1669015665
Name:CHANG, CHENG-CHI
Entity Type:Individual
Prefix:MR
First Name:CHENG-CHI
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 HARBOR BAY PKWY # 105
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6596
Mailing Address - Country:US
Mailing Address - Phone:510-835-2777
Mailing Address - Fax:
Practice Address - Street 1:1141 HARBOR BAY PKWY # 105
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502-6596
Practice Address - Country:US
Practice Address - Phone:510-835-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program